The burden of family planning lies on the woman even as she struggles with patriarchal control over her body, preference for male children, limited access to pregnancy control measures and men’s apathy towards the issue.
In a workshop held by Transform Rural India (TRI) on women’s empowerment and strengthening community-based organisations to attain gender equality in Madhya Pradesh, young women cadres shared experiences that highlighted the need for enhanced bodily autonomy and fertility control. Despite an increase in the level of education and slightly improved access to health services, patriarchal control over women’s bodies and fertility continues.
Preference for male children, lack of spacing between babies, dearth of information on pregnancy control measures and men’s apathy towards family planning leave the burden on women to manage the issue. They then take recourse to tubectomies. Malnourishment and anaemia also leave her body vulnerable. Misconceptions around vasectomy that it causes loss of potency and leads to weakness prevents men from coming forward.
Women’s bodies are instrumentalised for giving births in the expectation of a male progeny. They are also the ones to be subjected to family planning. Adolescents are not exposed to sufficient information about life-skills, sexuality and reproductive health. Access to sub-centres and primary health centres is not easy due to lack of functional centres and regularity in services, and unavailability of medicines. Abortion is often used as a sex-selective mechanism and amniocentesis rather than a family planning measure.
In a workshop in Jharkhand aimed at engendering livelihoods and understanding the underpinnings of gender equality in enhancing quality of life, the community resource persons narrated instances of women giving birth to several girl children until she could bear a boy. Women avoid using any family planning measures for fear of being thrown out of the family due to the inability to bear a male child.
There are few awareness programmes held for discussion on reproductive health measures and the need for family planning among men and women. Poor women do not often realise that copper-T has been inserted into her bodies. Anecdotal evidences showed that she realised it only when she experienced severe bleeding or irregular menstruation.
The United Nations Population Fund (UNFPA) has declared India as the most populous country with 8 billion people. At the same time, the replacement fertility rate has fallen below 2.1 children per woman (the figure that signifies stability of population), showing successful population control measures.
Family planning programmes and mechanisms initiated since the first five-year plans have succeeded in developing awareness on family planning methods. Women’s access to contraceptives and tubectomies has been enhanced. National Health Mission has ensured improvement in services of institutional delivery, and pre-natal and post- natal care. Social security measures like Janani Suraksha Yojana and cash transfers have admirably improved institutional deliveries. Services of Asha and anganwadi workers have improved immunisation, pre-natal check-ups and registration of pregnancies.
Targeting and instrumentalisation of women’s bodies has severely impacted informed decision-making over bodies and fertility. Skewed sex ratio of 929 per 1,000 male children, as evidenced in the NFHS-5 data, is due to abysmally low decision-making capacities and male preferences in the patriarchal institutions of the family. The need for the male child leads to an increased number of children.
Inadequate awareness on sexuality, reproductive health and family planning leads to lack of spacing and inadequate family planning measures. As many as 37.9 percent women undergo tubectomy as the only family planning method whereas only 0.3 percent men undergo vasectomy, as per the NFHS–5 data. There are no institutionalised mechanisms to create awareness on these aspects either through National Health Mission (NHM)) or women and child development schemes.
Spaces or platforms to impart sex education and conduct discussions on sexuality have not been created through schools, educational curriculum or informal adolescents’ groups or through Asha activists of NHM in the villages. Women still feel shame and embarrassment around their body and they are schooled on notions of virginity and sanctity of the vagina, but not on seeking reproductive healthcare.
Men are conditioned to hold notions about masculinity and misconceptions around vasectomy lead to absolving them of responsibility about taking up family planning measures. Access to health and wellness centres, availability of staff and medicine, and regularity and quality of services at Primary Health Centres also remains challenging in deprived blocks.
It is imperative that gender equality goals should be embedded in the reproductive health and population control programmes. Women’s agency in bodily autonomy, sex education for adolescent boys and girls and awareness of women to make informed decisions on reproductive health and family planning are key to achieving this. The National Health Mission and women and child development initiatives can make concerted endeavour to empower women for agency enhancement. The platforms of the well-knit structures of community-based organisations can also be utilised for dissemination of knowledge.
The lead image at the top is a representational image (Photo courtesy Canva)
Seema Bhaskaran is Lead – Inclusion and Equality at Transform Rural India Foundation. She has a postgraduation in social work and a doctorate in child sexual abuse. She serves as a consultant on gender integration and right to education for NRLM and UNICEF among others.
